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? ece.vee.by zrZ <br /> DEPARTMENT OF PUBLIC WORKS : <br /> Qr►J `�. DRIVEWAY AND PAVED FRONTAGES ——� <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> VJOB#11005 ISSUE DATE 1 / <br /> N FEE DUE DATE DRIVEWAYS:EET s'/���AREA— ' <br /> UAD 51F • <br /> C'ty,State- 'p Code TYPE <br /> ` ORIS 55 L� tt R-l7 <br /> Code) 01 phone NOTE <br /> / O TIO <br /> Parcel Name _ <br /> 1z 21 <br /> G� r <br /> Site sa <br /> DRIVEWAY <br /> TYPE QUANTITY. WIDTHS <br /> City,State- ip Code AGRICULTURE <br /> (a3 FRONTAGE <br /> CONMMCIAL <br /> (Area Code)Telophase <br /> US <br /> TRIAL @ R/W <br /> ENCE <br /> CONTRACTOR ' PAVED FRONTAGE <br /> X WIDTH: - Ft. <br /> Name <br /> The undersigned hereby applies far permission to encroach m Highway <br /> Address Right-0f-Way ani tlu ��urh+ silo of K"e <br /> � ly-i cit &J6Sr' _of �rE1 wF-6[+'C <br /> City,State-Zip Coda R a. .by installing t � <br /> (Area Code)Telephone <br /> VND <br /> Wary <br /> VAR commence on or about for approximately �Ys <br /> SKETCH(Separate sheet may be submitted) <br /> i <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aco=\Per App\Farm1kivemyNvod finatage <br />